DYNAMICS OF DISEASE TRANSMISSION

THEORIES AND MODELS OF DISEASE CAUSATION

• GERM TEORY
• THEORY OF EPIDEMIOLOGICAL TRIAD
• MULTI FACTORIAL CAUSATION THEORY
• WEB OF CAUSATION
• DEVERS EPIDEMIOLOGICAL MODEL

1. GERM THEORY
• It becomes popular during the 19th and early part of 2Qth century.
• This theory attributes micro-organisms as the only cause of disease.
causative
agent

cause man

effect disease

THEORY OF EPIDEMIOLOGICAL TRIAD

 This model is also called as ecological model and evolved through the study of infectious disease. Acc.
 To this model there are three elements or major factors which are responsible for a particular disease
causation. i.e. agent, host & environment.
 The agent refers to primary factor, without which a particular disease can not occur.
 The host refers to human beings who come in contact with the agent.
 The environment includes all, that is external to the host and agent but that may influence interaction
between them.

agent host

environment

MULTI FACTORIAL CAUSATION THEORY

• Disease caused by multiple factors .
4. WEB OF CAUSATION
Given by macmohan and pugh. according to him disease never depends upon single isolated cause rather it develops
from a chain of causation in which each link itself is a result of complex interaction of preceding events these chain
of causation which may be the fraction of the whole complex is known as web of causation.

• DEVERS EPIDEMIOLOGICAL MODEL

• This model is composed of four major categories of factors

 human biology
 lifestyle
 environment and
 health system
all these factors influence health status positively or negatively.
Human biological --- epidemiological triad and include genetic inheritance, complex physiological systems, factors
related to maturation and ageing
 Life style factors include daily living activities, customs, traditions, health habits etc
 Environmental factors include physical, biological, social and spiritual components
 D Health care system factors include availability, accessibility, adequacy and use of health care services at all
levels.
 Communicable diseases are transmitted from the reservoir/ source of infection to susceptible host.

DYNAMICS OF DISEASE TRANSMISSION

There are three links in the chain of transmission

1. Reservoir
2. Mode of transmission
3. Susceptible host

SOURCE OF MODE OF SUSCEPTIBLE

RESERVOIR TRANSMISSON HOST

1. SOURCE & RESERVOIR

• SOURCE -The source defined as the "person, animal, object or substance from which an infectious agent passes or
disseminated to the host".
• RESERVOIR -A reservoir is defined as "any person, animal, arthropod, plant, soil or substance in which an
infectious agent lives and multiplies , on which it depends primarily for survival, and where it reproduces itself in
such manner that it can be transmitted to a susceptible host".

• Eg:- In hookworm infection, the reservoir is man and the source of infection is soil contaminated with
infective larvae.

In typhoid fever the reservoir is a case or carrier and the source of infection is faeces or urine of patient or
contaminated food and water.

Types of reservoir
1. Human reservoir
2. Animal reservoir
3. Reservoir in non living things

1. HUMAN RESERVOIR
 The most important source or reservoir of infection for human is man himself.
 Human may be
o Case
o Carrier
  CASES -A case is defined as " a person in the population having the particular disease, health disorder or
condition under investigation".
 The presence of infection in host may be:-
o Clinical
o Sub clinical
o Latent

1. Clinical illness:-

• Clinical illness may be mild or moderate, typical or atypical, severe or fatal.

• Mild cases may be more important source of infection than severe cases.

2. Sub clinical cases

• Sub clinical cases are also known as in apparent, missed or abortive cases.

• The disease agent may multiply in the host but does not manifest itself by signs and
symptoms.

• Sub clinical infection may be detected only by laboratory tests.

3.Latent infection

• Infectious agent lies dormant within the host without symptoms.

1. Primary case:- first case of a communicable disease introduced into the population.

2. Secondary case:- develops from contact with primary cases.

3. Index case:-first case which comes to the attention of investigator

CARRIERS
• In some diseases, either due to inadequate treatment or immune response, the disease agent is not completely
eliminated, leading to a carrier state.

• A carrier is defined as an infected person or animal that harbours a specific infectious agent and serves as a
potential source of infection for others.

• The elements in a carrier state are

o The presence of disease agent in the body.

o The absence of recognizable signs and symptoms
o Spread of disease agent in the discharges or excretions.

A. TYPE
o lncubatory
o Convalescent
o Healthy
B. DURATION
o Temporary
o Chronic
C. PORTAL OF EXIT
o Urinary
o Intestinal
o Respiratory
o Others
A. TYPE
a. lncubatorv carriers
 o Carriers which spread the infectious agent during the incubation period of disease.
o This usually occurs during the last few days of incubation period.
o Eg:- measles, mumps, polio, influenza, hepatitis B
b. Convalescent carriers
o Carriers which continue to spread disease during the period of convalescence.
o Eg ;-Typhoid, Dysentery, Cholera, Diptheria
c. Healthy carriers
o They are victims of sub clinical infection who have developed carrier state without suffering from overt
disease.
o A person whose infection remains subclinical may or may not be a carrier.

B.DURATION
a. Temporary carriers
o Carriers which spread infectious agent for short period of time
b. Chronic carriers
o Carriers which spread infectious agent for indefinite period

C.PORTAL LOF EXIT

a. Urinary
b. Intestinal
c. Respiratory
d. Others -(skin eruptions, open wounds, blood)

2. Animal reservoir
• The source of infection may sometimes be animals and birds.

• The diseases and infections which are transmissible to man from vertebrate are called zoonoses.

• Eg :- Rabies, Yellow Fever, Influenza

3. Reservoir in non living things

• Soil and inanimate matter can also act as reservoir of infection

 MODE OF TRANSMISSION
Communicable diseases are transmitted from reservoir to host in many different ways

SOURCE OF MODE OF SUSCEPTIBLE

RESERVOIR TRANSMISSON HOST
 • 1 .Droplet contact
DIRECT • 2. Droplet infection
• 3. Contact with soil
TRANSMISSION • 4. Inoculation into skin or mucosa
• 5. Transplacental

• 1. Vehicle borne
• 2. Vector borne
INDIRECT • 3. Air borne
TRANSMISSION • 4. Fomite borne
• 5. Unclean hands and fingers

 DIRECT TRANSMISSION
1. Direct contact
• Infection may be transmitted by direct contact from skin to skin, mucosa to mucosa, or mucosa to
skin.
• Eg :- STD, AIDS, leprosy, leptospirosis, skin and eye infections
2. Droplet infection
• This is direct projection of spray of droplets of saliva and nasopharyngeal secretions during coughing,
sneezing, talking or spitting.
• The droplet spread is usually limited to a distance of 30-60 cm between source and host
• Eg :-Respiratory Infections, Common Cold, Tuberculosis, Diphtheria
3. Contact with soil:-
• The disease agent may be acquired by direct exposure to the disease agent in the soil
• Eg :- hook worm, tetanus, mycosis
4. Inoculation into skin:-
• Disease agent may be inoculated directly into the skin or mucosa
• Eg:-rabies virus by dog bite, Hepatitis B by contaminated needles
5. Transelacental transmissin:-
• Disease agents can be transmitted transplacentally.
o S-Syphilis
o T-Toxoplasma
o 0-0ther infections(AIDS, varicella, Hepatitis B)
o R-Rubella virus
o C-Cytomegalo virus
o H-Herpes virus

 INDIRECT TRANSMISSION
1. VEHICLE BORNE
• Vehicle borne transmission implies transmission of the infectious agent through the agency of water,
food, raw vegetables, fruits, milk, blood etc.
2. VECTOR BORNE
• Classification of vector borne disease
a. By vector
o Invertebrate Eg-arthropods( flies, mosquitoes, cockroach, ticks, mites, bugs)
 o Vertebrate Eg-mice, rodents
b. By transmission chain
o Man and a non vertebrate host (man-mosquitoe- man in malaria)
o Man , another vertebrate host and a non vertebrate host (bird-arthropod-man)
o Man and 2 intermediate host (man-cyclops-fish-man)
c. By methods in which vectors transmit agent
o Biting
o Scratching
d. By methods in which vectors are involved in the transmission of parasite
o Mechanical transmission
o Biological transmission
3. AIR BORNE
• Droplet nuclei
• Dust
4. FOMITE BORNE
• Fomites are inanimate articles or substances other than water or food contaminated by infectious
agents.
• Eg-soiled clothes, syringes, instruments etc.
5. UNCLEAN HANDS
• Lack of personal hygiene favour personperson transmission of infection.

SUSCEPTIBLE HOST

SOURCE OF MODE OF SUSCEPTIBLE

RESERVOIR TRANSMISSON HOST

SUCESSFUL PARASITISM
• 4 stages are there in successful parasitism

SURVIVAL IN
PORTAL OF SITE OF
PORTAL OF EXIT THE
ENTRY SELECTION
ENVIRONMENT

1. PORTAL OF ENTRY
• Infectious agent enter the host Eg-
o Respiratory tract
o Alimentary tract
o Genito urinary tract
o Skin
 2. SITE OF ELECTION
• In the body the disease agent finds appropriate tissue for multiplication and survival
3. PORTAL OF EXIT
• The disease agent finds a way out of the body
4. SURVIVAL OUTSIDE
• After leaving the human body the organism must survive in the external environment for sufficient
period till a new host is found

Diseases prevention and control

• Prevention of source or reservoir
• Early diagnosis
• Notification
• Epidemiological Investigation
• Isolation
• Treatment
• Quarantine
• Interruption of the disease transmission
• Prevention of susceptible host
• Immunization
• Health education